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Activism Made AIDS Treatment More Accessible — That’s What It’ll Take for COVID

AIDS researcher Sam Friedman discusses the lessons learned from the movement to lower prices for vital AIDS treatments.

Participants in the Global Day of Action AIDS march and rally set out from Washington Square Park on the way to Sixth Ave in New York City, circa 2000.

Part of the Series

While many in the U.S. have breathed an understandable sigh of relief as COVID cases sharply decline across the country, cases have continued to climb across much of the world where the number of available vaccines ranges from few to none. And after President Joe Biden came out in support of waiving intellectual property protections for coronavirus vaccines, the pharmaceutical industry began furiously lobbying governments in Germany, Japan, and elsewhere to maintain the patents that block other companies and labs from increasing the global vaccine supply.

The global fight for affordable COVID vaccines is becoming one of the defining issues of our time, and it has many lessons to learn from the struggle to win global access to AIDS treatment drugs. For the past three decades, coalitions like the South Africa’s Treatment Access Campaign have mounted successful campaigns against drug companies making obscene profits from AIDS medications that many sufferers of the disease couldn’t afford. There are many parallels between the impact of AIDS and COVID within the United States as well, especially the disproportionate impact both diseases have had on poor people of color — and the outrageous disregard that policy makers have displayed toward them.

Sam Friedman is an international AIDS researcher who has specialized since the early 1980s in studying HIV harm reduction among people who use drugs. He is also a longtime socialist writer and activist who has written about subjects ranging from rank-and-file organizing inside the Teamsters union to the global movement for access to affordable AIDS treatment. In this interview, Friedman talks about the lessons to be drawn from the movement to lower prices for vital AIDS treatments, why both AIDS and COVID have disproportionately hit poor people of color, and why people who rightfully mistrust pharmaceutical executives should still believe in the effectiveness of their vaccines.

Danny Katch: The current fight against to make COVID vaccines accessible and affordable across the world builds on the long struggle to do the same for AIDS treatments. What lessons can activists can draw today from that movement?

Sam Friedman: First, AIDS activists had to fight the U.S. government to get more research funding and for fast-track methods to make promising drugs available to those getting sick and dying. They won on this, so academic researchers worked with pharmaceutical companies to develop and test promising drugs. The pharmaceutical companies patented them and sold them at high prices to make great profits. Researchers and companies also tried to create vaccines for HIV — with no success so far, but they learned a lot about immunology and viruses that I’m sure contributed enormously to developing COVID vaccines and therapies.

In course of the AIDS struggles, community groups organized first to get research done. Later, they remobilized to make the drugs available all over the world at a price people could afford. That involved lots of struggles — including some mass actions in South Africa — and threats by certain governments (who had pharmaceutical industries in their own countries) to break the patents based on a public necessity argument. This was first fought and won in Brazil, and then India got involved. Now, in 2021, we are waging similar fights to make COVID vaccines available.

Importantly, every time the drug companies change their formulations at all, they can reopen negotiations. So, this led to a series of interminable negotiations over prices that led to the bureaucratization of the community side.

The movements around AIDS have been activist and powerful enough to get the U.S., UN, and foundations to promise to fund treatment for everyone who got infected. This has saved millions of lives, and helped pharmaceutical companies to be among the most profitable in the world — but nonetheless, these countries and institutions have never provided sufficient funds and probably never will. And almost a million people still die of AIDS every year.

Are there common patterns in which populations have been hit hardest by AIDS and COVID?

The viruses have enormously different patterns and ways to spread. COVID peak infectivity lasts for four to seven days; AIDS, initial infectivity lasts for months before the immune system reduces to a lower level, but you continue to be modestly infectious until you die or medicines make you noninfectious. In addition, the viruses spread differently. The three major ways that people get infected with HIV are sex, injection and being born to somebody infected with HIV — in the absence of any protection in each case. COVID spreads widely, mainly through the air.

And yet remarkably, though not surprisingly to epidemiologists or anyone who knows anything about public health, in the United States, Black and Latino people are hit harder by both COVID and AIDS. At first, it looked like COVID was hitting the middle class and the rich countries because they’re the ones who could be in the airplanes and transmit it to their friends, but it rapidly shifted away from that class and away from white folks. The global response to COVID, like AIDS, reproduces racial forms of oppression.

Who gets arrested and put in prisons where people get infected? Who’s working in the meatpacking plants? Who are in the really cruddy jobs in hospitals with patient contact but the least ability in the early days to get access to personal protective equipment? Migrant agricultural workers are another niche for the disease, as are the immigrant concentration camps along the border.

And then with vaccinations, people talk about hesitancy and the fact that racially oppressed communities don’t trust the public health system — which is only reasonable given the history. But in addition, they are more likely to have to take care of kids when they’re not at work because their spouse, if they have one, is working the other shift. So how can you get to a vaccine?

Do you see parallels in the way the people most vulnerable to AIDS and COVID have been treated by political leaders?

In both diseases, those who have died were to a large extent from groups that corporations and/or politicians see as “disposable people.”

In 1989, Ernest Quimby and I wrote an article about the politics of AIDS and the Black community in New York City. We described how what we then called “propriety politics” led to the widespread distancing of community leaders from drug users. It led many politicians and preachers, and those who respected those politicians and preachers, into taking positions against needle exchange programs that could have saved many lives. Basically, the position was, we don’t care, they’re messing up our neighborhoods, let them die. Nonetheless, a lot of people in the neighborhoods that were getting messed up by drugs, drug raids and drug deals were very supportive of needle exchange — it was their children or fathers and mothers who were getting AIDS. But who would talk to them?

Gay men were also seen as disposable. Jesse Helms, senator from North Carolina, proposed an amendment that barred federal funding for AIDS programs that “condone homosexual activities” and it passed the Senate. Ronald Reagan didn’t mention the word AIDS for many years at least in public.

With COVID, the presidential order forcing people back into the meatpacking plants that were spreading the virus was a horrible thing to do and should have been defied and met with a general strike. Then there’s the Great Barrington Declaration, which even some on the left have written in support of, which basically said to use herd immunity in the sense of let everyone get infected, and to essentially put old people in isolation to protect them, which is a horrible thing to do. I’m an old person — I don’t want to be put aside or treated as disposable.

In both epidemics, we have had to fight for everything we could get.

Many people might think that denialism and conspiracy theories around COVID and now the vaccine is a new phenomenon, but wasn’t there also denial of the scientific understanding of AIDS?

Yes, at first some people thought it was caused by drug use and a “dissolute life” — the wages of sin and all the rest — and Peter Duesberg, a scientist from another field, made a case in 1987 that the Koch Principles proving something was an infectious disease hadn’t been met, and that a behavior like drug use directly caused AIDS rather than the HIV virus. It seemed defensible at the time, it got published in a respectable medical journal and had some well-respected supporters. But then medicines were designed to precisely attack the HIV virus, people took them, and cures happened. The medicines attacking HIV were clearly preventing AIDS. At that point, all intellectual respectability for the Duesberg thesis stopped. But he stuck by his guns and he had a lot of followers, which ultimately grew to include the president of South Africa, and through that, became public policy in South Africa in the late 1990s and early 2000s. It became a huge international fight and scandal, and many people died from AIDS.

Later, in the early years of the Iraq War, I remember talking to a member of my antiwar group who was totally convinced AIDS wasn’t caused by HIV. Nothing I said convinced her. She’s currently a COVID vaccine opponent — every day or two, she puts an article or argument against vaccines on our group’s listserv. So, there’s some continuity. I think it goes deeply into the alienation that’s endemic under capitalism, and the well-rooted distrust for institutions. I always tell people: Don’t trust the government, don’t trust pharmaceutical companies, but be intelligent about it. Don’t be paranoid.

So that leads to the million-dollar question: Why should people take the vaccine if we are understandably mistrustful of the pharmaceutical companies that produce them?

The first reason people should take vaccines, and it goes against a lot of the reigning “Me first” ideology of this country, is that not getting the vaccine can kill other people. Every vaccine-hesitant person, every person we’re not able to reach with a vaccine, every person who takes only one shot of a two-shot vaccine, is a potential breeder of mutants. And that may be the mutant which starts spreading and kills 20 million people or more. So, the key reason to take the vaccine is to protect other people. All arguments people make about side effects or this, that, and the other have to be taken with that in mind. I can listen to them case by case with my friends and be sympathetic, but ultimately, they’re playing with other people’s lives, and if they don’t take that into account in their personal calculus, I have no respect for that. Particularly if they pretend to be left or progressive.

But underlying that is the question of why we should we trust the science in this case. First of all, we do have to understand that pharmaceutical companies are in it for the money. Governments are there to keep the people down so that corporations can make money. No one is our friend in an official position. We have to fight them tooth and nail all the time. I do not trust governments or corporations, either.

That said, corporations can’t get away with lying about COVID vaccines. Look at the amount of research that’s already been done by independent groups tracing the effects of the vaccines on public health. Look at what happened to AstraZeneca and Johnson & Johnson because of side effects that basically are negligible compared to the damage that COVID does.

If companies tried to fake the effects of the vaccine in a clinical trial, the chances are reasonably high they’d be caught by the FDA group, but they’re also very high that their own scientists would leak it. Scientists usually respect truth, and even scientists corrupted by pharmaceutical salaries would be reluctant to fudge trial results when they or their friends and families might die from COVID because of it.

There is a populist (as opposed to a Marxist) thread in a progressivism that blames everything on the greed of corporations and doesn’t look at the systematics of capitalism. It doesn’t take into account that the other capitalists need their workers all over the world, doesn’t take into account the fact that the people who do the research are themselves workers and they’re not about to screw themselves and their families for money — a few will, but a company cannot count on all of them to do it. So, you’ve got to step back from the paranoia and ask how likely companies would be to get away with it.

And the good news is that the vaccines seem to be doing remarkably well, with few people having bad side effects. But the bad news is that companies and governments are putting profits ahead of lives once again, and many millions of people who cannot get vaccines are dying.

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